Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 21 June 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Combination treatment with infliximab recommended for IBD

This month's issue of Inflammatory Bowel Diseases evaluates combination immunosuppression in IBD. 

News image

Whether to use biologic treatment for inflammatory bowel disease as monotherapy or in combination with immunosuppressives has been a matter of debate in the last 2 decades.

Combination therapy was not superior in any of the registration trials for Crohn’s disease and ulcerative colitis for tumor necrosis factor antagonists, vedolizumab, or ustekinumab.

It needs to be mentioned, though, that none of these trials were powered to detect such differences, and that many patients entered the trial after having failed conventional immunosuppressives.

Postmarketing studies revealed that patients on background immunosuppression have a lower risk of immunogenicity than patients on monotherapy.

Professor Geert D'Haens and colleagues from the Netherlands demonstrated in the SONIC and UC-SUCCESS trials superiority of the combination azathioprine-infliximab in Crohn’s disease and ulcerative colitis, respectively.

Toxicity could perhaps be reduced by using lower doses of immunosuppressives
Inflammatory Bowel Diseases


This trial design has not been used with any other biologic for inflammatory bowel disease, so far.

It has also become clear that combination treatment with tumor necrosis factor antagonists is associated with increased toxicity, mainly infections, but also malignancy such as lymphoproliferative disease.

The researchers found that this toxicity could perhaps be reduced by using lower doses of immunosuppressives, a strategy that has been shown to be equally potent in reducing immunogenicity.

Additionally, combination treatment could be used for a limited period of time since most immunogenicity develops in the beginning of the biologic treatment.

Patients who develop anti-drug-antibodies later on can often be rescued by reintroduction of thiopurines or methotrexate.

Professor D'Haens' team comments, "In summary, combination treatment is certainly beneficial with infliximab, at least in the first 12 months of treatment."

"With other tumor necrosis factor antagonists, vedolizumab, and ustekinumab, the available data do not offer clear guidance."

"In patients without increased risk of toxicity, and certainly in those with limited treatment options, it may be wise to offer combination treatment with all biologics for the time being and at least during the initiation phase."

Inflammatory Bowel Diseases 2018: 24 (3)539–545
08 March 2018

Go to top of page Email this page Email this page to a colleague

 31 May 2018 
Diagnostic for NAFLD  
 31 May 2018 
Bile acids and the risks for hepatotoxicity
 31 May 2018 
Rectal cancer female sexuality score
 30 May 2018 
Fungal dysbiosis in cirrhosis
 30 May 2018 
Placebo rates in ulcerative colitis trials
 30 May 2018 
Follow-up testing and colorectal cancer mortality
 29 May 2018 
Organ transplantation donors
 29 May 2018 
Novel therapies for IBD
 29 May 2018 
Helicobacter pylori infection to stomach cancer
 28 May 2018 
Mesalazine in ulcerative colitis
 28 May 2018 
Technology and management of digestive diseases
 28 May 2018 
Therapeutic strategies for HCV
 25 May 2018 
Post‐operative complications in elderly IBD
 25 May 2018 
Technology to increase colorectal cancer screening
 25 May 2018 
Colorectal cancer–specific mortality
 24 May 2018 
Alcohol consumption and outcomes in drug-induced liver injury
 24 May 2018 
Patient-reported outcome measures in IBD trials
 24 May 2018 
Precision medicine for tumors
 23 May 2018 
Management of perianal fistulas in Crohn’s disease
 23 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 23 May 2018 
High body mass index is and ulcerative colitis
 22 May 2018 
Worldwide H.pylori prevalence
 22 May 2018 
PPI and risk of stroke
 22 May 2018 
Online tool predicts bowel dysfunction severity prior to anterior resection
 21 May 2018 
PPI use and cognitive decline
 21 May 2018 
Depressive symptoms in IBD youth
 21 May 2018 
Fecal incontinence and quality of life in IBD
 18 May 2018 
Esophageal dilatation in clinical practice 
 17 May 2018 
IBD and later extraintestinal manifestations
 17 May 2018 
Repeat stool DNA testing
 17 May 2018 
IBS and chronic fatigue following GI infection
 16 May 2018 
Factors associated with fecal incontinence
 16 May 2018 
Diagnostic delay in Crohn's disease
 16 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 15 May 2018 
Guidelines for management of Crohn's
 15 May 2018 
New therapies for CDI
 15 May 2018 
Hep B in the Grey Zone
 14 May 2018 
Blood test for the diagnosis of fibrotic NASH
 14 May 2018 
Outcomes at bariatric centers of excellence
 14 May 2018 
Management of perianal fistulas in Crohn’s
 11 May 2018 
Detection of undiagnosed celiac disease
 11 May 2018 
Alcohol consumption and drug-induced liver injury
 10 May 2018 
Colorectal cancer screening
 10 May 2018 
Fibrosis in patients with chronic hepatitis B
 09 May 2018 
Fecal incontinence
 09 May 2018 
Health problems and IBS
 09 May 2018 
Esophageal dilatation in clinical practice 
 07 May 2018 
Health problems and IBS
 07 May 2018 
Assessment of diminutive colorectal polyps
 07 May 2018 
Omitting antibiotics in uncomplicated acute diverticulitis
 04 May 2018 
National Institutes of Health workshop and obesity
 04 May 2018 
Factors associated with fecal incontinence
 04 May 2018 
Colorectal cancer screening and ethnic inequities
 03 May 2018 
Gastrointestinal ultrasound in IBD
 03 May 2018 
Ultransonography in postsurgical recurrence in Crohn's
 02 May 2018 
Chronic Hep B
 02 May 2018 
Hep C antiviral treatment and liver cancer risk
 02 May 2018 
Symptom assessment in cirrhotic ascites
 01 May 2018 
Interferon‐free regimens in Hep C
 01 May 2018 
European guidelines on pancreatic cystic neoplasms

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us